Why America’s Aging Population is not the reason for the Legacy of Debt

Mario D. Garrett – February 20, 2011

AMERICANS HAVE a looming obligated deficit of $63.6 trillion—a figure which is more than what the Gross Domestic Product (GDP) of the entire world produces ($61.1 trillion), and about four times the GDP of the United States ($14.6 trillion.) This is the largest single debt in the world’s history.

Some blame all or part of this deficit on an aging population, arguing that increasing cost in health care spending, Medicare and Social Security are the main culprits for this obligated debt. Others point to the growing deficits that we build annually into our federal budget, driven by our military spending and pork barrel earmarks. In 2011, we have added an additional $1.6 trillion to the national deficit. If, as some economists predict, our current ailing economy will continue to suffer, then it is imperative to question the legacy that we are leaving our children and grandchildren, and to examine the real reason why we have a deficit and whether an aging population is to blame. This article goes beyond the clichés and the sound bites to expose the  underlying dynamics of how aging in America came about and how the obligated deficit has been created. The aging of America exposes a radical and political game changer.

The reality of an aging population is that it has been driven by social factors rather than by people living longer. In the last century (1900-2000) in the United States, life expectancy for 65 year olds has increased by only 5.7 years. This is less then present difference in life expectancy at birth between Whites and Blacks in America—which is 6.3 years. Instead, two of the most important contributing factors to the aging of populations are the decline in births and the decline in infant mortality. These two phenomena go hand-in-hand.

While the decline in infant mortality was orchestrated by improved sanitation, clean water, improved diet and the introduction of immunization—a decline in the birth rate came about as a result of women becoming better educated. Better-educated women have fewer children—because they are either studying/working, they have reduced incentive and opportunity to bear many children—and they tend to have children later in life, with greater lag in-between bearing children. With better education come better personal health practices, more nurturing of infants and consequently better survival through infancy.

Women’s educational attainment in the United States (both high school and college) shot up in the fifties partly due to the GI Bill and increased federal funding for higher education. Beginning after WWII, the nation’s share of female workers rose from less than 25 percent to 38 percent (1970) to 47 percent (2009). The ripple effect from this simple yet dynamic social change is far reaching. The crude birth rate (number of births per 1,000 people) went up at the end of the Second World War peaking at 26 followed by a gradual decline to fewer than 15—which created the baby boom. Over the next six decades these baby boomers started to become older: while the decline in the birth rate continued. So much so that in developed countries, the fertility rate has dipped below replacement level and is still plummeting despite policies in Europe that are attempting to reverse it. This has serious implications as we shall see.

A decline in the number of children means that our labor market will shrink. This is important because we euphemistically refer to Social Security—which also applies to Medicare as well—as a “pay-as-you-go” system. This means that money that workers pay today goes to support the benefits of existing retirees. If we have fewer workers paying into the system, while at the same time experiencing a growing population of beneficiaries, then we have a problem of how to pay these entitlements. In the past we had a surplus with more workers than beneficiaries.

When there was a surplus, the government spent it. For this expenditure, the government prints out treasury special issues—known as trust fund bonds that are not real bonds since they cannot be sold or exchanged. Even the interest on these trust fund bonds are again paid in treasury special issues trust fund bonds. People mistake these bonds as real. Unlike other treasury bonds, these are printed on paper and are filed away in a four-drawer cabinet. However the 2009 Social Security Trustees Report was explicit in explaining that: "Neither the redemption of trust fund bonds, nor interest paid on those bonds, provides any new net income to the Treasury, which must finance redemptions and interest payments through some combination of increased taxation, reductions in other government spending, or additional borrowing from the public." This means that these are not funds or bonds, since to pay this money back the government itself admits that it will have to raise taxes, borrow more, or print additional monies to honor them. The government cannot sell these trust fund bonds on the market because they are worthless. The trust fund bonds are paper IOUs that are valueless unless the government can repay them.

Started by President Reagan—and followed by all other presidents—this newly establish Social Security surplus, was put into the general fund. As a result, each year’s surplus is spent every year. At different times, three members of Congress expressed public outrage at this practice; these were Senators Daniel Patrick Moynihan of NY, Harry Reid of NV, and Ernest Hollings of SC. What was needed was a law to separate these Social Security surpluses away from the budget so that they do not get spent and instead get invested for the benefit of future retirees. This is exactly the law that President Bush signed in 1990. The Budget Enforcement Act—Section 13301—made it illegal for Congress to use Social Security funds by excluding Social Security from all budgets including the congressional budget (taking it “off budget”). However to this day, this law is ignored. If that surplus remained in a fund, then the solvency of Social Security would not be jeopardized. If the fund still existed, Social Security would not have to rely solely on future cohorts. Congress robbed the cookie jar and is now blaming the very people that put the cookies in the jar in the first place.

Congress has not had the ability to stay within budget (apart from 1999 and 2000) and it is unlikely that they will save enough to be capable of honoring the obligation for Social Security which stands at $7.6 trillion, and the obligation for Medicare which stands at $38.1 trillion. More telling is that there is no such budget plan by Congress to ever do so. This year, 2011, our annual Social Security surpluses have disappeared. Not only do we have to contend with a deficit every year—with no surplus money coming from Social Security—but we also have to find money to start paying retirees from sources other than Social Security contributions. The sad part of this story is that we have known this will happen for at least three decades.

The 1982 Greenspan Commission was established to study and make recommendations to Congress on how to solve the Social Security obligations when the baby boomers mature. The recommendation was for a major payroll tax hike to generate Social Security surpluses for the next 30 years, in order to build up a large reserve in the trust fund that could be drawn when the boomers become retirees—now. In effect, the 1982 increases in contributions meant that the baby boomers funded for their eventual retirement as well as funding the benefits of the retirees at the time. This created a massive surplus. A surplus that was designed to fund the eventual retirement benefits of the baby boomers. However, as we have seen, these surpluses were never invested, they were spent.

The other part of this double jeopardy concerns Medicare. Medicare by far is the largest federal obligation, and will overshadow all other budget items within the federal government. By 2007, total spending on health care in the United States was $2.3 trillion or $7,600 per person. The percentage of GDP that is spent on national health is projected to continue to increase (from 5.2 percent in 1960 to 20 percent in 2016), which translates to $4.2 trillion. Rising health care costs are an emergent issue especially for the United States. By comparison, Switzerland, Germany and France allocated around 11 percent of their GDP to health. But despite this enormous outlay of resources on health services in the United States, these dollars do not translate to better health.

While health care costs in the United States are mushrooming—consuming a greater part of our GDP—there exist no comparable improved health outcomes, such as improved life expectancy. The United States continues to slide further behind other countries in health status. In 1997, the U.S. ranked 15th in mortality. Since then, Finland, Portugal, the United Kingdom and Ireland have reduced the rate of preventable deaths more rapidly than the United States. Similarly disappointing are results of child well-being, in which the U.S. ranked second to last when compared to twenty one countries similar to the United States in terms of their economies.

If U.S. health care costs are not contributing to improved health, where are resources going? The United States spends six times more per capita on the administration of the health care system than its peer Western European nations. Moreover, more U.S. health care costs are primarily expended on the dying. During the five-year period 2001–05, nearly a third of total Medicare spending—31.7 percent—went toward the care of moribund patients with severe chronic illness during their last two years of life. It seems that our health system has not learned how to deal with an aging population that naturally dies. And it will continue to ignore the moral, ethical and economic issues as long as other cohorts are footing the bill.

Both Social Security and Medicare surpluses—ostensibly different and separate programs—are comingled in one big trough from which both Democrats and Republicans feed. Some have referred to social security—and, by association, Medicare—as a ponzi scheme. Its viability depends on an intergenerational exchange. Those that contribute into the system today, pay for all benefits of today’s retirees. Implicit in this arrangement is that future contributors into social security would then pay for the current workers when they retire in the future. This intergenerational exchange is more demanding on future cohorts since the proportion of workers to retirees will decrease. Future cohorts will continue to bear a larger and larger responsibility for paying off previous debt.

But future cohorts are changing. The intergenerational exchange becomes an interethnic exchange. By 2050, minorities—those who identify themselves as Hispanic, black, Asian, American Indian, Native Hawaiian, Pacific Islander or mixed race—will account for 54 percent of the U.S. population (currently 34%), which is projected to total 439 million that year. Among the nation’s children, the trend is even more pronounced so that by 2050, this will jump to 62 percent (compared to 44 percent today).

Immigration is playing a leading role in both the growth and changing composition of the U.S. population, points out the Pew Research Center. It finds that immigrants and their descendants will account for 82 percent of the projected population increase from 2005 to 2050. Nearly 20 percent of Americans will be foreign born in 2050, compared with 12 percent in 2005, the center projects. On the other side of the Medicare/Social Security equation, one in five people will be 65 and older by 2050 and 59 percent will be White. While by 2050, there will be 19 million people age 85 and older and 67percent will be White.

So the weight of the Medicare/Social Security burden will be borne primarily by minorities—and immigrants—for the benefit of predominantly White retirees. By the time these younger largely minority cohorts, who have contributed towards the benefits of the emerging baby boomers, get to retire themselves, these benefits will be dramatically reduced since the solvency of Medicare/Social Security can only be achieved by an increase in contributions and/or a decrease in benefits.

This inequity is further exacerbated because of the diminished life expectancy of minorities compared to Whites. Minorities do not receive the same total level of benefits as Whites because they die earlier. Predictions indicated that life expectancy will decline and will primarily affect minorities. There is also a disproportionate level of contribution from minorities because Social Security contribution is capped at $106,800, minorities, on the whole, contribute at the full percentage, while the mainly White—and in smaller numbers, Asian—pay an increasingly smaller percentage the higher their income is above the cap.

The demographics that determine an uneven playing field are dictating that minorities will pay more into Medicare/Social Security—more minority younger cohorts with a  higher percentage contribution into Social Security—but they will benefit less due to shorter life expectancy, and smaller individual contributions. But the inequity is that minorities depend on social security to a greater degree than Whites. A much higher percentage of minorities relied on Social Security for all of their income; 33 percent of Blacks and 33 percent of Hispanics, compared with only 16 percent of Whites. The reality of an intergenerational and interethnic exchange becomes more apparent because we need to further promote it to be able to stay economically viable.

We are witnessing a chronically sick economy driven by a narcissistic political system that does not have any long term objectives and which is not held accountable for its excesses. We stand as a nation in a quandary and there are no real solutions come through the densely managed media. As with anyone facing a major health issues, the prognosis calls for radical change. We need to change how we do business, again.

How do we move forward to bring about change? A Bloomberg National Poll of December 2010 reported that three quarters of respondents saw unemployment, jobs, Federal deficit and spending most important issue facing the country right now. As with most terminal diagnosis the prognosis needs to be radical. There is a need for invasive and strategic change in how we are doing business. In order to bring about change we need to start a discussion on issues that elicit visceral reactions in most people. We need to put these on the table and to engage the public to understand these interventions: and then to implement change. Dissent is the voice of change.

• Medicare. We have to deal with health care costs if we are going to be serious about economic reform, and Medicare costs are prime for change. A third of all costs go toward the care of patients during their last two years of life. Although we do not know when some patients will die, we do know which patients prefer to not have invasive interventions. We need to honor people’s wish to die with dignity. Death among frail older adults is not a failure. Physician assisted suicide and voluntary refusal for food and fluids needs to be part of any geriatric program including Medicare.

• Eliminate administration. In business cutting overhead and administration and focusing on the product is what keeps the company competitive. The same needs to be true in our economy. Where there are large administrative bodies such as in education, health, government or military, the role of administration needs to be reexamined. One example is to replace layers of defunct bureaucracy with computer technology. For example, information technology can be used for health care surveillance and monitoring where individual prescriptions can be tracked digitally to reduce the possibility of drug to drug interaction.

• Education for all. The primary engine for the economy and health is education. Educational opportunities should be expanded to ensure that those who have a capacity to learn have the opportunity to do so, and for those with diminished capacity to offer remedial education for life. School needs to be de-centralized with more public education taken on at libraries, adult enrichment centers, community colleges, high schools and work settings. Re-employment funds that will sponsor workers in new jobs for up to a certain number of years, will replace unemployment benefit. This will provide an incentive for the employer to hire more workers, and provide an incentive for the worker to re-train in emerging industries. Being unemployed should never be an option.

• Eliminate insurance companies from Health Care. At least 24% of every healthcare dollar goes toward insurance firms’ administrative expenses and payment processes. The use of computerized technology–including innovative smart card technology, mHealth, telemedicine and other technology driven application to improve healthcare services–would make middlemen insurers unnecessary.

• Separate funds for Social Security and Medicare. Keep the surpluses off budget. Social Security and Medicare are the most successful programs in our history and they have contributed to a more equitable society. Remove the cap on contribution from Social Security (currently at $106,800). Ensure a generous sliding scale so that those who are less needy receive less benefit then those who depend completely on these programs. Allow survivors benefits to only one ex-spouse. Include all workers into the program. Currently some workers can opt out. Make it a national program without any “opting out” options.

• Promote Immigration. Over the long run, a net inflow of immigrants equal to 1% of employment increases income per worker by 0.6% to 0.9%. This implies that total immigration to the United States from 1990 to 2007 was associated with a 6.6% to 9.9% increase in real income per worker. That equals to an increase of about $5,100 in the yearly income of the average U.S. worker in constant 2005 dollars. Such a gain equals 20% to 25% of the total real increase in average yearly income per worker registered in the United States between 1990 and 2007.

As with any terminal diagnosis the remedy might be repugnant, but these interventions are necessary in order to truly change the way we are doing business in America. By definition, changing how we do business needs to be radical in order to be effective, and bring about change. It is a legacy that we need to promote. As with the social factors that brought about the aging of America, we need to change social structure in order to effectively accommodate these changes. By becoming more equitable, we would regain our legacy and we can ensure that we have successfully passed the baton to our more diverse children.

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Mario Garrett is a psychologist and professor at San Diego State University. He has worked at the United Nations International Institute on Aging, and universities in London, Bristol, Bath, Malta, Texas and New Mexico.

Conceptual Solution to Elder Abuse

Nothing makes it faster into the newspapers then a sensational story of physical or sexual abuse of a vulnerable person. We find such atrocities repugnant. Each incident diminishes our expectations of ourselves as civilized—we become less human. 

What distinguishes elder abuse from any other type of abuse is that—sadly—it is all too predictable. We can predict with some level of accurately who is prone to elder abuse in terms of both becoming a victim, and becoming abusive. Unlike any other type of abuse, elder abuse is predictable.

The few statistics that we have show that those who become abused are more likely to be isolated female with some form of vulnerability, whether that is physical or mental. Also, an abused older adult suffering from dementia makes it less easy to prosecute. By the time the case makes it through the ponderous legal system there is a likely chance that cognitive impairment has become more pronounced. People who experience violence tend to suffer dementia earlier, faster.

On the other hand, those who abuse are more likely to be male family members, most often the victim’s adult child or spouse. The familial relationship makes it that much harder to report. Research has shown that the abusers in many instances are financially dependent on the elder’s resources and have alcohol and drugs problems. A study by Arnold S. Brown from Northern Arizona University, showed that a large number of people who commit elder abuse have themselves been abused as children. Abuse is a learned behavior.  

How we deal with abuse as a society is unfortunately outdated. The response grew from treating elder abuse like child abuse.  The current system of prosecuting cases in court is untenable. There is also a dark side of how law is used. In terms of financial abuse, there is growing anecdotal evidence suggesting that older adults are being denied access to their bank funds because of concerns that they are withdrawing too much money. There is a fine line between protecting the older adults and treating them as children. 

Even if there is financial abuse and the case—as an exception—makes it to court, in virtually all cases little of the stolen money is recovered.  In cases of physical abuse the ponderous slowness of the legal profession that does not protect the victim from escalation and in some cases fatality. But the overwhelming concern is the demographic revolution that will overwhelm the system purely on the number of frail older adults that are emerging.

The solution is therefore to prevent abuse from happening. Being predictable helps us to prevent it. Canadians are ahead of us here. They developed an effective “buddy system” where volunteers befriend vulnerable older adults. In order to not loose our humanity we need to be more social. Perhaps the reason we feel less civilized is because we have become less civilized, we have lost our social capital.  An excellent summary of such a program is to be found at the University of California at Irvine website, www.centeronelderabuse.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

The Age of Psychology

Human populations across the world are changing. They are becoming older, both in terms of the number of older adults and in terms of how many older adults there are to the younger population. Such changes have an effect on numerous issues such as funding and provision of housing, transportation, income and health.

Health is perhaps that most important of these changes because it affects us personally, is usually irreversible, and affects all the other issues directly. With an aging population, pattern of diseases have changed.  Throughout our life, most have experienced a death of a close acquaintance due to an infection or an accident. We all remember some great epidemics that have hit the Unites States.  Killing 500,000 people, the 1918 outbreak of Spanish influenza was the worst single U.S. epidemic. This was followed in 1949 by the polio epidemic when 42,173 cases were reported with 2,720 deaths.  More recently, another polio epidemic three years later in 1952 that killed 3,300 with 57,628 cases reported.

We are going through another epidemic now. An epidemic that was discovered in 1981 with AIDS, with a total estimated 988,376 U.S. AIDS cases with 550,394 deaths. The most recent epidemic was the 2009 H1N1 epidemic known as Swine Flu, affected more than 70 countries with 22 million Americans contracting the virus, and when about 3,900 Americans died.

Such seemingly catastrophic and unnecessary deaths pail in comparison to deaths from chronic diseases which are becoming more and more common because of an aging population. Chronic diseases--such as heart disease, stroke, cancer, diabetes, and arthritis--are among the most common, costly, and preventable of all health problems in the U.S.  Seven out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.

And chronic diseases not only cause death they diminish the quality of life. In 2005, 133 million Americans--almost half of all adults--had at least one chronic illness.  Arthritis is the most common cause of disability, with nearly 19 million Americans reporting activity limitations. Diabetes continues to be the leading cause of kidney failure, non-accident lower-extremity amputations, and blindness among adults.

Out of this changing situation, the fastest growing cause of death in America is however due to dementia. Unlike heart disease and cancer death rates--which are continuing to decline--deaths from Alzheimer’s disease are on the rise. Alzheimer’s disease is the 5th leading cause of death for adults aged 65 years and older. Driven by the sheer numbers of older adults, an estimated 5.4 million Americans have Alzheimer’s disease. This number has doubled since 1980, and is expected to be as high as 16 million by 2050. Julie Bynum, from the Dartmouth Institute Center for Health Policy Research estimated that Medicare and Medicaid spending for individuals with Alzheimer’s disease in 2011 is $130 billion.

While clinical intervention have proved inconsequential in reversing this trend, psychology, and the science of neurology will become more significant disciplines in addressing this new age.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

Older Adults in Films: The Invisible Older Woman

According to the Nielsen Company’s market research, Americans increased their television viewing in 2010 to an astounding average of 34 hours per person per week. In addition, that same year, more than three out of four Americans went to the movies at least once. Latinos, followed by Blacks, went more often than Whites.

But how much does our fascination with media shape our views of reality?  The content of the tv shows and films we love provides a distorted representation of our society. The impression we receive is that older adults are the exception. Although prime time television portrays many young adults (20–34 years old), significantly fewer older adults appear on screen. Older adults make up about 3% of television characters, but comprise almost 15% of the total population. This finding is consistent throughout the short history of television.  The same pattern emerges when we examine television advertising, game shows and cartoons. Fewer than one in 20 of all characters is aged 55 years and older. Even in soap operas—typically replete with older-looking actors—older adults are still under-represented, although appearances go up to 8%. The same is true for magazine advertisements, where older adults comprise only about 6% of the images. It seems that the pictorial media is shunning older adults.

And women fair much worse than men. Older men appear as much as ten times as frequently as older women, with a similar pattern among characters in children’s television cartoons. Approximately 77% of older characters on those shows are male. As for ethnicity, a 2002 study that examined 835 television characters found only four African American characters over the age of 60, and other ethnic groups were almost totally absent from the 60+ age group. They are have become invisible in television and film.

In America, advertising that portrays older adults overwhelmingly associates them with health-related products. Interestingly, seniors appear even if these products are for ailments that are not particularly age-related (e.g., allergy medications). In advertisements related to Alzheimer’s disease, long-term institutionalization, and loss of bladder control, older adults are invariably shown as being happy, smiling and generally being amiable.

Television and film executives argue that older adults do not comprise their primary target audiences. They argue that older clients stick with the same products. But do not tell that to Lexus. By providing an excellent quality product and customer support, older people did switch brands. Perhaps older adults are waiting for the right quality product. Moreover, one look at television will tell you that perhaps that product is not out yet. Nevertheless, perhaps there is a possibility with film.

The Coming of Age film festival—which première’s its second year on January 12, 2012 at Balboa Park’s Museum of Photographic Arts (MOPA)—will highlight how some films can represent older adults realistically. The champion of older adults, Florida Senator Claude Pepper once lamented: “Are the elderly the lepers of television, ostracized from public view?” 

Not yet.  The Coming of Age festival is addressing that imbalance, one film at a time. To book free seats, call MOPA at  619-238-7559 or visit their website at www.mopa.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Seeing through Ages

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One of our greatest fears is becoming dependent. Blindness and vision impairment—which increase with age—directly contribute to dependency, presenting challenges to families and caregivers.

National studies indicate that vision loss is associated with diabetes, heart disease, stroke, death, falls and injuries, depression, and social isolation. It also compromises our quality of life because it diminishes our ability to read, drive, walk, watch entertainment and participate actively in visual art. Eventually vision loss and blindness isolates us from others.

Vision impairment comprises an important public health issue for older adults, affecting one out of six older Americans.  Vision impairments double in persons aged 80 years compared with persons ten years younger. Although more than half of those with impaired vision could improve their eyesight by using prescription lexes, others experience underlying diseases that can result in blindness.

Because eyes are such refined organs in the body, they are prone to damage through increase in blood pressure. Anything that contributes to blood pressure can therefore directly cause blindness—smoking, high cholesterol, being overweight and diabetes. These serious diseases include diabetic retinopathy, cataract, glaucoma, and macular degeneration. Vision problems might start slowly, but they have serious consequences that can lead to blindness. In many cases, blindness can be prevented through early detection and treatment.

Cataracts, the most common eye disease, afflict nearly one in three older adults. A cataract is a clouding of the eye’s lens. More than 15 million Americans aged 65 years or older have a cataract in one or both eyes. By 2020, the estimated number of people aged 40 or older with cataracts is expected to rise to more than 30 million.

Afflicting one in ten older adults, glaucoma and age-related macular degeneration (AMD) are the second most common type of eye diseases among older adults.

Glaucoma is caused by fluid pressure which damages the eye’s optic nerve. Both slow- and fast-developing (painful) glaucoma characterize this disease which is more prevalent among Blacks and Latinos. The number of glaucoma cases specifically among Latinos aged 65 years or older who have diabetes is expected to increase 12-fold by 2050.

On the other hand, AMD affects the central part of the retina (macula), occurring in both wet and dry forms. Wet AMD occurs when blood vessels start leaking under the macula, impairing the senses. While dry AMD—the most common in about 90% of cases—is where the macula thins over time.  AMD is more likely to affect Whites and accounts for half of all blindness among White Americans.  AMD cases are expected to double by 2050, increasing to 17.8 million.

Among older adults who reported moderate or extreme vision loss, one out of four reported that cost prevented them from seeking eye care. In some cases a balanced nutritional supplement can save your eyesight. Older adults should know that Medicare pays for glaucoma screening, cataract removal, and treatment of macular degeneration in some cases. Although Medicare does not pay for routine eye examinations or glasses, numerous agencies offer free or reduced-rate examinations. Your local adult enrichment center should have more details. Eye Care America (http://www.eyecareamerica.org/), run by volunteer ophthalmologists, offers no cost screenings to those who qualify.

Aristotle and Cool Old Age

Science does not have to look to ancient Greece for ideas. Even so, some of the assumptions that we have about aging are ancient. Ask anyone what they think about getting older and you will notice that we have not progressed very much recently—the central theme that emerges about aging involves attrition and running out of juice.

The idea of attrition started with Aristotle (384-322 BC) and was later adopted by the Romans, Muslim and Western European medical establishments.  It became the basis for our early understanding of how the human body works.  Essentially, Aristotle held that the human body was filled with four humors: black bile, yellow bile, phlegm, and blood. Any imbalance in these four humors resulted in diseases and disabilities. Aging is caused by the drying out and cooling of these humors. This idea had a wide following, and involved numerous hot baths and saunas in order to maintian our wetness and innate heat. 

Surprisingly, older adults do have slightly lower temperatures. The 98.6° F benchmark for body temperature comes from Carl Wunderlich—a 19th-century German physician.  In 2005,  Irving Gomolin from Winthrop University Hospital in New York, found that older people have lower temperatures than this average. In a study of 150 older people with an average age of 80-plus, they found the average temperature to be 97.7°. What is fascinating is that the older you are, the lower your body temperature.

This finding does not by itself dispute Aristotle’s. Since older people are more likely to die, then a decline in temperature would seem to indicate that their “innate heat” is ebbing.  But recent 2006 research, led by Italian researcher Bruno Conti at the Scripps Research Institute, has shown that a decline in body temperature is beneficial. The study found that mice who had lower core body temperatures lived 12% (male) to 20% (female) longer than mice with higher core body temperatures. The difference in temperatures between "cold" and "normal" mice was 0.5-0.9 F (0.3-0.5 C), which is the same difference between the average person and older adults.

The science behind this anomaly is just now becoming clear to us. One of the known ways to increase longevity is to restrict our calories. Caloric restriction increases life- and healthspan in all sorts of animals.  Several studies have reported that animals on reduced calorie diets also had a lowering of core body temperature.

It could be that lowering of the body core temperature is one way of slowing the aging process. Thus the reason older adults may have lower body temperature is not because they are dying, but because it is nature’s strategy for keeping them alive longer. In the Baltimore Longitudinal Study of Aging, men with a core body temperature below the average (median) lived significantly longer than men with body temperature above the average. Being cool is, well, cool.

Cicero and the Attitude of Aging

With all the scientific interest in anti-aging products, and all the money spent on procedures to make us look younger, healthier and more vibrant, a single reality still stands at the end of the day:  Aging is inevitable.  Being conscious of this will save you a lot of heartache (and money.)

Researchers and authors continue to discuss how best to describe ideal aging.  From Successful Aging, to Healthy Aging, to what we now call Conscious Aging, the central theme is to accept our limitations but to not let them determine who we are.

In contrast to philosophers who came before him, Cicero (106-40BC) was the first person to acknowledge aging as a period of diminished abilities but concluded that this—by itself—was not negative. Cicero had in fact articulated our current concept of psychological aging—of being conscious of the aging process and adapting accordingly.

While everyone around him searched for the holy grail of anti-aging, Cicero advocated acceptance. Reflecting his training as a diplomat, he argued that old age was a time of transition, not despair. Even though we might withdraw from active pursuits, he argued, older adults can still fulfill advisory functions. Cicero championed the belief that old age was not a disease—that we should accept our limitations and actively engage in those activities which we can still perform. It’s all about attitude. Make sure that your cup is half full.

In 2002, in a now classic study by two Yale professors, Becca Levy and Martin Slade, supported Cicero’s ideas. The researchers surveyed 660 individuals aged 50 and older on their perceptions about aging. Twenty three years later, they found that older individuals with more positive self-perceptions of aging—recorded 23 years earlier—lived 7.5 years longer than those with less positive self-perceptions of aging. This advantage remained after age, gender, income, loneliness, and functional health were included as possible factors. The findings suggest that self-perceptions influence longevity.

This year a new test is set to hit the market in Britain that measures a person’s telomeres. Telomeres are structures found on the tips of chromosomes that correlate with how fast a person is aging biologically. Predicted by Leonard Hayflick—before their discovery—telomeres tell us how many times our cells have already divided (and because the number of times is finite, we can tell how many times they can continue to replicate until they die).  Will such a test change how you behave?

It is likley that it will in a posive way. In 2005 Chris O’Brien surveyed over 3500 individuals in Britain, on how long they expected to live. On average—compared to local statistics—they under-estimated. Males estimated that thy will die 4.62 years earlier and women 5.95 years earlier than they are likely to die.  In this case, undertaking the blood test would improve our expectation of living longer. Attitude determines not just our longevity but it makes living more than just an expresssion of our telomeres.

Taoist Orgasms and Older Adults

Sometimes we joke about how other civilization, or other ages, looked upon old age. Since we have “medical-ized” aging and death, we have shielded ourselves from experiencing other ways of understanding aging. For many of us, aging refers just to the physical and mental breakdown of the body. But before modern science, the only way to learn about aging was through philosophy and religion.

Chinese philosophers probably thought about longevity and aging before anyone else. Early Taoist thinking—some 2000 BC—contended that there is an energy substance contained in the human body known as Jing—and that once your Jing has been expended, you will die. This comprised a simple but compelling explanation. Jing could be lost from the body in a variety of ways—most notably through bodily fluids.

Taoists embraced extensive practices to stimulate/increase and conserve their bodily fluids. The fluid that contained the most Jing was male semen.  Taoist men attempted to decrease the frequency of, or totally avoided ejaculation—in some cases redirecting the ejaculation—in order to conserve their life essence.  Others reportedly recycled and composted their own fecal matter as fertilizer for their crops—human manure. The Jing was the most precious of all substances because it was life personified.

With women surviving longer than men, later Taoist teachings needed to completely ignore females in order to make assertions about longevity hold. In addition to this major omission, recent studies also debunk the myth of a Jing. Studies published in the last few years show that sex, ejaculation and orgasms have the opposite effect of Taoist predictions.

In 2011 Howard Friedman correlated the “orgasm adequacy of wives” with longevity. Using data gathered from a group of 1,500 California students in the 1920’s—and following them throughout their lives—Friedman was able to correlate their sexual activities with longevity. The results were exciting. Women who had more orgasms during intercourse tended to live longer than their less responsive peers. 

For men, a 2009 British study interviewed nearly 918 men aged 45 to 59 about their sexual frequency. Ten years later, when all death records were forwarded to the researchers, they measured the subjects’ life spans. The findings were conclusive. Men who had two or more orgasms a week had died at a rate half that of the men who had orgasms less than once a month. Ejaculating more than 100 times a year increases life expectancy by 5-8 years.

The causes of longevity might include more than sexual climax. Although the climax by itself has positive neural and chemical effcts on the body, it may be that the pre-existing conditions for sex are equally or more important.  Conditions which allow for sex—and its fulfillment—to take place might be more important than the climax itself. These factors may include being healthy, gregarious, active, a certain level of hygiene and cognitive functioning, physical capacity, as well as certain level of social adaptness. All, by themselves, may comprise strong correlates of longevity, without the climax. However, these studies do debunk myths that conserving the Jing will promote living longer.  

Hearing loss

A sure sign that you’re becoming hard of hearing, is that you start noticing that people mumble. And they do—it just wasn’t an issue before. When Ludwig Van Beethoven went deaf he was still able to create music and play music. However, although he could “hear” his music, he still could not hear the applause of his audience.

Hearing loss in older age has repercussions beyond individual sensory loss.  Those close to you start to get irritated with you. Some might stop talking to you altogether.  As frustrating as this may be for you, remember that it is also frustrating for friends and family members. Hearing plays a key part in how we communicate—talking on the phone, listening to the television or radio, and our daily face-to-face conversations. Loss of hearing creates difficulties in our primary means of communicating. Even so, the difficulty of accepting change—and especially change in our personal health—causes many people to blame anything and everything before admitting that their hearing isn’t what it used to be. But if these symptoms are familiar, you may need help.

Late-onset deafness—after age 65—usually results from diminished functionality in the middle ear. There are two primary causes. One is an erosion of microscopic blood vessels in the middle ear causes hearing loss but often does not affect the individual's ability to hear and understand speech.

The second degeneration is caused by loss of the ear's tiny 'hair' cells—known clinically as presbycusis. Presbycusis can have a more serious affect on the ability to understand speech. Vital components of speech sounds, usually the higher pitched consonants which define speech, become indistinguishable. For this reason many people first experience difficulty in understanding women and children—and since men are more likely than women to have hearing impairment, this can and does create psychological friction. Lower pitched male voices are often easier to hear and comprehend. As hearing deteriorates, the ability to understand speech becomes more severely affected.

While Whites and Latinos have a higher prevalence of hearing problems than Blacks, sensory impairments create a substantial problem for older Americans in general: One out of four has impaired hearing, and hearing impairments double from age 70 to age 80.  As U.S. life expectancy increases, the prevalence of hearing impairments among older adults will increase—impacting our ability to maintain independence, health, and quality of life.

Some people may have a genetic predisposition to hearing loss.  For others, diet and lifestyle may play a role. For example, exposure to noise or pressure, such as diving or flying, in one’s earlier years will hasten the onset of noticeable hearing loss. Other factors including osteoporosis and diuretic medications may also contribute directly to diminished hearing.

Vanity plays a major barrier to acknowledging that our hearing is not what it used to be and that we need hearing aids. Hearing aids have improved, but still noticeable and the quality remains a compromise. But successful aging means understanding our limitations, and overcoming them. Aging is a privilege, attesting to the fact that we have surmounted many of the inconvenient barriers that life has thrown at us.

Medicine and Religion at the end of life.

There are no guidebooks about getting old. Each of us experiences aging differently and we each deal with these changes in our own way. When we are younger, we have a very general sense—perhaps a distant idea—about aging.  But generally, our ideas don’t get more refined until we actually experience changes associated with aging.  These changes slowly make us aware about our eventual death.

Most of us have come across statistics about death, but these facts get blurred.  It is uncomfortable to think about death.  But while growing old may be a privilege, death is a certainty.

The British geriatrician Arthur Norman Exton-Smith—in a classic study—found that nearly half of his dying elderly patients were delirious at the time of death.  Despite the availability of hospice care both at home and hospital which often provides palliative care that deals with the pain rather than the disease—most people either do not utilize this service or use it too late. As a result, widespread distress about death remains common.

A study in 1997 by Joanne Lynn and her colleagues at George Washington University interviewed family members of older adults who died in hospitals. The authors reported that four in ten patients had severe pain most of the time. Overall, one in ten patients had a final resuscitation attempt. One fourth of patients were put under a ventilator, and a feeding tube was used in four tenths of patients. Under these circumstances death becomes a medical and technological failure.

With this overwhelming failure, some look to religion for answers. It is not by chance that all religions deal with death.  Most have fairly elaborate rituals that formalize how the dying person—and their loved ones—deal with life’s end-game.

Despite its historical role in filling this vacuum, some religions today seem to be diluting these important rituals. How prepared are faith leaders to deal with their constituents’ end-of-life issues? A number of Master theses within the Department of Gerontology and Religious Studies at SDSU have attempted to answer this question, resulting in some surprising answers.

The studies found that despite growing numbers of older constituents, most faith leaders are ill-equipped to deal with such issues. Religious leaders often receive little formal training in dealing with end-of-life issues; devote very little time to dying congregational members; and most surprisingly, are not comfortable talking about death.

Both religion and medicine are coming together to address the needs of people at the end-of-life. The evolving methods to deal with death is a central mission of hospice care—started in the 1950s by Dame Cicely Saunders, an Oxford graduate. Modern day hospice has evolved to include the spiritual as well as the palliative. In addition to providing spiritual and palliative care to the patient, one of the evolving roles is to provide spiritual counseling, respite and education for grieving loved ones. Sometimes continuing this support to the family even after the patient has died. Dealing with death requires help, support and some guidance to understanding its finality. 

Dreaming of Traveling

An AARP national telephone survey of 29,000 older adults recently asked people to describe their “top dream.”

Surprisingly, it was to travel. Two out of  five older adults said that vacation and travel was their top dream, ranked above hobbies and interests (15%); kids, grandkids, family and friends (13%); faith and spirituality (6%); good health (6%); and career, job and work (5%). So it comes as of little surprise that a 2007 survey of 30,000 consumers age 42+ by the New York-based Focalyst—found more than 81 million older adults who were planning to travel in the next year planned to spend a total of $126 billion. This economic potential does not go unnoticed by the travel industry.

More than 100 million Americans today are age 45 or older, their households accounting for 91% of the America’s net worth. This group represents the largest, fastest growing, richest consumer market on the planet, accounting for half of earth’s consumer spending.

However, do not think that Club Med might refer to Medication rather than Mediterranean, as these older traveling consumers enjoy both health and wealth. Research of older adults has resulted in the shattering of some stereotypes. Boomers are the wealthiest generation in history, and even though only 9 percent are truly affluent—defined as having pre-tax incomes of $150,000 or more if working, or $100,000 or more if retired—this 9 percent will transform travel as we know it.

It seems there is no limit to what American adventure travel will entail.  Travel brochures promote Everest treks, tours to Galapagos turtle breeding grounds, retreats at monasteries, and romps in exotic naughty places. Although France is the top tourist destination in the world with 75 million visitors in 2009, America makes the most money from tourism—more than $87 billion. In addition, Americans have become the top international tourists abroad. In around half of all international travelling, Americans end up in Western Europe and of these, one in five go to Britain, and equally to France and Germany (combined). Asia is the second destination for a quarter of all Americans’ international trips.

This resurgence of travel among older Americans may reflect not only affluence, but could be a backlash to years of work in careers that offered little opportunity for travel while working. On average, Americans have half as many holidays as workers in other developed countries. Workers in Italy—which surpasses all countries—have more than two-month annual holidays. American workers, at the bottom of the vacation list, average just over two weeks holiday a year. Retirement becomes an opportunity to make up for lost time.

In such a highly dynamic environment, airlines need to develop specific marketing strategies to cater to the needs of older travelers. In terms of representing the needs of boomers and the aging population, cruise ships are currently doing a better job than airlines. And there is no loyalty, more than half of all Boomers agree that in today’s marketplace, it doesn’t pay to be loyal to one brand or one method of travel. We are in for some radical changes.

Ageless Animals

Not all immortal beings come to us from Hollywood. In the same league as Peter Pan, Dracula and The Highlander, nature’s real-life examples of immortal beings include the turritopsis nutricula. This fairly small species of jellyfish—at 0.18inches—may be the only animal in the world to have truly discovered the fountain of youth. It can cycle from a mature adult to an immature polyp stage—its first stage of life—and back again. We do not know whether turritopsis nutricula retains any memory, or if it goes through an endless cycle of brainless regeneration—much like Hollywood's creations. It could be using its own body to provide the nutrients for a new being. The same mistake was made by French eugenist Alex Carrel, the Nobel prize winner in 1912, when he kept chicken heart cells alive “indefinitely” by feeding them stem cells.

The modern crusade to find immortality continues. However exciting turritopsis nutricula might be for biologists, it does not stir the hearts of modern Americans, who are accustomed to drawing their inspiration from fictional ideals. Besides, immortality has one simple problem to surmount, but it is a big one--physics.

One of the few all-encompassing laws in biology, which is determined in turn by physics, is Kleiber's Law. Max Klieber, a Swiss agricultural chemist, predicted that mass determines metabolism, and metabolism determines longevity. Larger animals live longer.

Kleiber’s Law, however, was complicated by Caleb Finch from the University of Southern California who, while researching aging among animals, found "negligible" aging among rougheye rockfish (who can live up to 205 years), sturgeon (150 years for females), giant tortoise (152 years), bivalves and possibly lobsters. These included no observable age-related increases in mortality rate or decreases in reproduction rate after maturity, and no observable age-related decline in physiological capacity or disease resistance. Finch coined the term "negligible senescence" to describe very slow or negligible aging. But these are just freaks of nature, exceptions to the rule. Or are they?

All this was changed dramatically by a little known experiment in the 1970's. Michael Rose began manipulating the life spans of fruit flies. He allowed fruit flies to reproduce only at late ages. This forced researchers to pay attention to the survival and reproductive vigor of the flies through their middle age. The flies evolved longer life spans and greater reproduction over the next dozen generations. This demonstrated that a “death clock” exists in each of us--which nature can re-set to give us a better chance of reproducing.

This is the kind of stuff that scientists can manipulate. And that is exactly the work done at UC San Francisco by Cynthia Kenyon--who by manipulating genes in the flatworm nearly doubled their life span. These long-lived worms still looked and acted younger than their control group brethren. This changed the way we think about aging on two counts. First, that a death clock exists that can be modified by manipulating genes, and second that longevity is associated with being healthy.

Ageless animals have thought us that there are two ways to live longer: increasing the lifespan and slowing down the aging process. Individually all we can do for now is to try to not accelerate aging by excessive behaviors.

My Personal Experiences of Aging

You can follow my personal experiences of aging on my blog:
iaging.blogspot.com

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Wiser Older Adults

Everyone has a different definition of wisdom, but we all agree that is it something that is desirable. Aristotle was one of the first to argue for the importance of practical over theoretical knowledge in determining what wisdom is. Historically—when survival to older age was less certain—it was assumed that survivors were wise. They had the practical know how to survive. However, practical knowledge is no easier concept to define.

In a 2007 study, Fredda Blanchard-Fields and Susanne Scheibe showed a disturbing video for two groups of adults, ages 20-30 and 60-75. They then they asked them to ignore what they have just watched and to play a memory game. People in the older age group performed better on the memory test. It seems that older adults are better at separating their feelings and looking at the practical task at hand. This ability allows older adults to remain positive in the light of accumulating negative experiences.

Despite multiple chronic illnesses that cause functional disability or cognitive decline, most older adults are able to tune out negative information into their late 70s and 80s. The recent 2010 AARP study that looked at wellbeing also showed that despite reporting a decrease in high overall quality of life since five years ago (48% from 50%), everyone expects their quality of life to increase in five years time. It could be that the ability to be positive—despite the reality—allows for practical and therefore wise decisions. But happiness is not solely the privilege of older adults.

A study published this year in the Proceedings of the National Academy of Science found a U-shaped relationship between happiness and age: Adults were happiest in youth and again in their 70s and early 80s, and least happy in middle age. A 2007 University of Chicago study similarly concluded that rates of happiness—the degree to which a person evaluates the overall quality of his present life positively—crept upward from age 65 to 85 and beyond, in both sexes.

This paradox that exist for older adults and not for younger adults—that older adults are happier despite the likelihood of multiple chronic illnesses, functional disability, cognitive decline, and accumulating negative experiences—can be the definition of wisdom.

The ability for most older adults to be able to tune out negative information and evaluate the situation on a practical foundation is unique. Raising a family, navigating a career and experiencing love, loss, success and failure educate adults. It is the ability to see all of this and still manage to search for compromise, admitting uncertainty, overcoming fear and finding flexibility that is the seat of wisdom.

This explains that it is not simply life that is a precondition for wisdom. Aristotle insisted that only individuals with good character could acquire excellence in practical wisdom. And it seems that we have known this all along as the English philosopher Bertrand Russell (1872-1970) said “To conquer fear is the beginning of wisdom.”


Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Poverty is (really) on the Increase among Older Adults

Having $100 in San Diego is not the same as having $100 in Wichita, Kansas. Anyone can tell you that. But the federal government has ignored this for the past four decades.

The Federal Poverty Level, originally developed in 1963-1964 by Mollie Orshansky of the Social Security Administration, took the dollar costs of the U.S. Department of Agriculture’s economy food plan for families of three or more persons and multiplied the costs by a factor of three. As such the federal poverty level does not take into account housing costs, differences in living expenses across the country, child care, health care costs, medications and transportation. For older adults, the cost of food is the smallest cost when compared to housing costs, medications and health care—therefore the Federal Poverty Level becomes meaningless.

The 2010 Current Population Survey reported 43.6 million people living in poverty—the largest number in the 51 years for which poverty estimates have been published.

Surprisingly, the same report shows that between 2008 and 2009, poverty increased for children under age 18 (from 19.0 to 20.7 percent) and people aged 18 to 64 (from 11.7 to 12.9 percent), but decreased for older adults (from 9.7 to 8.9 percent).

Such statistics contrast wildly with today’s reality. Hardship among older adults can be gauged by increases in homelessness, having to return to work, demand for subsidized housing and requests for economic assistance. In response to the imprecision of the Federal Poverty Level, the National Academy of Science developed a new formula it hopes will replace the current one. This January, the federal government officially acknowledged the need to improve the outdated federal poverty level by releasing a ‘Supplemental Poverty Measure.’
California could not wait, having already embraced an alternate formula called the Elder Index. This index, calculated by the UCLA Center for Health Policy Research on behalf of the Insight Center for Community Economic Development, and Wider Opportunities for Women shows that the cost of living for California seniors far outpaces the Federal Poverty Level. The inadequacy of the Federal Poverty Level is important to California’s older adults as it determines eligibility for many public programs, determines funding allocations for other programs, and is used as an evaluation measure in determining program effectiveness.

The Elder Index estimates that 18.6 percent of Americans over 65 live below the poverty line, which translates to 6.8 million older adults. This index is more accurate than either the antiquated Federal Poverty Level or the Supplemental Poverty Measure because it takes into account the costs of child care, health care and transportation.

The Elder Index could take on added significance at a time when the government is flaunting an overhaul of Medicare and Social Security as its best hope for reducing the ballooning federal debt. With the potential to add more older Americans to the ranks of the poor, the numbers may underscore a need for continued—if not expanded—old-age benefits.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Ethnic Diversity Among Older Adults: Older adults becoming more diverse

By 2050 out of 439 million Americans, minorities—those Americans who identify themselves as Hispanic, Black, Asian, American Indian/Alaskan Native, Native Hawaiian, Pacific Islander or mixed race—will account for 54 percent of the U.S. population (currently 34%). Among the nation’s children, the trend is even more pronounced—jumping to 62 percent by 2050 (compared to 44 percent today). It will no longer be accurate to refer to these ethnically diverse groups as minorities.

Immigration plays a leading role in both the growth and changing composition of the U.S. population. Immigration is the single reason why the United States has not aged as fast as most European countries.

The Pew Research Center finds that immigrants and their descendants will account for 82 percent of the projected population increase from 2005 to 2050. Nearly 20 percent of Americans will be foreign-born in 2050, compared with 12 percent in 2005, the Center projects. On the other side of the age continuum, by 2050 one in five people will be 65 and older and 59 percent will be White. That same year, when 19 million people will be age 85 and older, 67 percent will be White.

These changes signal that America is changing color while aging. Although older adults are becoming more diverse, for the next four decades, we will have a predominantly White older group, and a predominantly ethnically diverse younger group following. This seems to create social tension, especially when older adults express less tolerant views of an ethnically diverse population.

A popular view holds that older adults hold more narrow views than younger adults because they grew up in a less tolerant era. However, recent research shows that—even though they might have ethnic biases—older adults are less able to regulate associations. For older adults, implicit racial biases—which we all have—are likely to be acted upon.

Although older adults might be perceived as biased against ethnically diverse younger populations, they must, at the same time, rely on these same populations to generate the funds for their federal benefits. Especially, in light of the fact that both Social Security and Medicare rely exclusively on younger workers’ contributions.

In what we euphemistically term “pay-as-you-go,” today’s younger workers—including undocumented workers—contribute to the benefits of current retirees. In a now outdated but pertinent 1994 study, Donald Huddle estimated that total revenues from undocumented workers was $10 billion, including $7 billion in Social Security taxes.

Because of proposed changes under discussion for Social Security and Medicare, any changes to these federal benefit systems will have grave impact on younger workers who are currently supporting today’s older adults. And these workers will predominantly be ethnically diverse. The “pay-as-you-go” system might become a “pay-and-go” system. Older adults have an obligations to maintain current privileges to younger Americans.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Gambling and the Older Adult: Losing More than Just Your Money

Older adults are gambling in record numbers. For the first time, a large number of older adults have disposable income. With fewer economic obligations, some retired older adults have increasing opportunities to engage in recreation and leisure activities. Americans view retirement as a time to have fun after a lifetime of responsibility, work, bosses, children, family and mortgages—and gambling seems an exciting form of recreation.

A new report from Richard K. Miller and Associates revealed that gross gaming revenue in the U.S. totaled $80.5 billion in 2009. And, according to Debbie Rull of the Union of Pan Asian Communities, San Diego County has ten casinos with a combined annual gross revenue of $1.5 billion, employing 13,000 workers with an annual payroll of $270 million. Gambling in San Diego attracts 40,000 people daily. Gambling by older adults is big business. Many retirees begin gambling without appreciating the risks.

Data suggest that recreational gambling provides both beneficial and detrimental effects. Among older adults, recreational gambling—like many enjoyable leisure activities—may create opportunities for socialization, mental stimulation, and other benefits. The majority of adults in the United States who gamble recreationally, do so at levels not considered problematic or pathological.

On the positive side, Rani Desai in 2004 found that in comparison to younger adults, older adults expressed fewer negative measures of health and wellbeing. Specifically, increased rates of alcohol abuse, substance abuse, and incarceration—found among younger recreational gamblers—did not occur among older recreational gaming participants. In addition, older gamblers reported feeling happier and had positive subjective ratings of general health then their non-gambling peers.

However, research also suggests that older adults may be particularly vulnerable to some gambling-related problems. Approximately one in twenty adults who participate in gaming have a problem or tendencies toward pathological gambling. Many older adult gamblers with fixed incomes are more vulnerable to financial devastation than younger gamblers. Whereas younger gamblers are more resilient to losses because they can recover income losses, for many older adults gambling can result in permanent poverty.

Older adult problem gamblers are less willing to seek timely help for their addiction. Approximately two-thirds of the older adult population has gambled in the past year. Over the past several decades, gambling participation has grown the most among older adults.

Although gambling can represent a safe way to socialize and spend a few hours being entertained, a small proportion of older adults find that the attraction consumes their focus. If you suspect that you have a problem, resources exist to help you. Between 1999 & 2003, California gambling addiction hotlines reported that calls from older adults increased by 25%. If you or your loved one need help, call the California Council on Problem Gambling (888) 250-2282 or you can reach them on their website www.calproblemgambling.org.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Older Drivers

In many Americans’ minds, independence is firmly connected to being able to drive. Our cities—especially San Diego—rely heavily on personal transportation options. But for an aging population, our transportation system needs to be—in the near future—very different from todays.
Changes in our bodies partly ensure that driving will become more precarious. Apart from clinical issues that affect some older adults, other, normal changes—things like diminished physical capacities—affect our driving competence.
Visual acuity begins to diminish in normal older adults. Night vision and peripheral vision both decline with age. At the same time, older Americans take more prescription medicines than any other age group. Several types of medication can make driving harder because they affect perception and our senses. Drugs that might interfere with driving include sleep aids, medicine to treat depression, antihistamines for allergies and colds, strong painkillers, and diabetes medications. Changes in sleep patterns start to affect how well we can concentrate. These events combine in an overture driving difficulties that are likely to result in death.
Despite these changes, the percentage of older people who continue driving is growing. The concern is that there is very little debate on the implications of this transformation. We are not preparing for the inevitable.
Apart from the promotion of the trolley (train) service, and small pilot programs looking at volunteer drivers, there is no state or city-level discussion on how the aging of our drivers will radical effect our transportation system and what options we have.
Even if baby boomers drive at the same (modest) rates as the current older population, their sheer numbers means that total miles driven by those 65 and older will increase by 50 percent by 2020 and more than double by 2040.
Although older drivers drive far fewer miles than younger drivers they are more likely to be injured or die in a crash of the same severity—older adults are frailer and they tend to drive older and less safe cars. Older cars are less safe, but 26 percent of drivers over the age of 80 are driving pre-1988 vehicles, compared to 16 percent of drivers under 60.
For most older adults personal transportation is very much a necessity. We will be seeing more older drives, more older cars, frailer less responsive drivers, resulting in a higher susceptible to injury and therefore increase road fatalities.
An innovative program currently running in Lincoln City, CA shows some promise. They have developed Neighborhood Electric Vehicle friendly city, that allow older adults access to city services and to connect to train and bus services for long distance travel.
For now there are a number of things you can do to improve your driving and your chances of survival. Think about taking a driving refresher class. AARP sponsors “55 ALIVE/Mature Driving.” Call 1-888-227-7669 . While AAA has a number of classes including some by Posit Science called DriveSharp. Driving safely ensures that you continue to retain your license as well as your life.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Older Adults are programmed to remember happy thoughts: Happiness Helps You Live Longer

A 2008 Gallup telephone survey of more than 340,000 adults in the United States found that people become happier and experience less worry after they reach the age of 50. In fact, by the age of 85, people are happier with their life than they were when they were 18 years old. Is happiness part of growing older, or do happy people live longer?

In 2011 Donna Rose Addis from the University of Auckland (NZ), and her colleagues, tried to answer this question. They published a study that reveals that older adults' ability to remember positive events is linked to the way in which the brain processes emotions. In the older adult brain, there are strong connections between those regions that process emotions and those known to be important for retaining memories. They asked young adults (ages 19-31) and older adults (ages 61-80) to view a series of photographs with positive and negative themes, such as a victorious skier or a wounded soldier. While participants viewed these images, a functional magnetic resonance imaging (fMRI) scan recorded their brain activity. In older adult brains, two regions that are linked to the processing of emotional content were strongly connected to regions that are linked to memory formation. These findings suggest that older adults remember the good times well because the brain regions that process positive emotions also process memory. Living longer makes you remember positive emotions better. Older adults experience an increase in positive thoughts and feelings, along with a decrease in negative emotions like anger and frustration.

But it is not a one way street. Positive emotions not only make you feel good they also reduce blood pressure, promote better heart health, reduce frailty and promote exercise and a healthy lifestyle. Numerous studies continue to show that living longer relates to this ability to see things in a positive light. Research found that older individuals with more positive self-perceptions of aging—measured up to 23 years earlier—lived 7.5 years longer than those with less positive self-perceptions. This advantage remained after accounting for differences in age, gender, socioeconomic status, loneliness, and functional health.

Being happy also relates to being philanthropic, giving back to people. Anthropologists point out that early developed societies practiced helping others as a social norm. There appears to be a fundamental human drive toward helping others. Evolution suggests that human nature evolved emotionally and behaviorally by increasing longevity for those that helps others. We seem to prosper under the protective influence of positive emotions.

Being happy was always seen as important. Enshrined in the Declaration of Independent is the phrase “…endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness…” Jefferson himself equated happiness with living a virtuous and useful life. "It is neither wealth nor splendor, but tranquility and occupation (meaningful work)," he said, "which give happiness." How very true, and most older adults know that so well.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Fear of Alzheimer’s Disease

Far from abating Americans’ concerns about Alzheimer’s disease, public awareness of the disease has increased fears for many. According to a 2010 survey by the MetLife Foundation, people over 55 dread getting Alzheimer’s more than any other disease (after cancer). Although 93 percent were aware of the disease, almost three-quarters say they know very little or nothing about Alzheimer’s.

We do know that the disease is unprecedented, the repercussions pervasive, the impact profound and the effects enduring. We can only hope that increased knowledge about Alzheimer’s will alleviate some of the anxiety.

Of the more than 100 types of dementias, the four main types are irreversible. These include Alzheimer’s disease (60% of cases); Vascular dementia (30–40%); Lewy bodies (15%); and Fronto-temporal dementia (5%).

Other less common dementias result from head injury and trauma; tumors; pressure of fluid in the brain; bacterial and viral infections; toxic, endocrine and metabolic causes; chronic alcoholism; and lack of oxygen. Whatever the cause of the disease, the effect on the brain is the same. It begins with a gradual and progressive reduction in the number of living cells in the brain. The brain slowly begins to die.

Some potentially reversible causes of dementia—although a small proportion—include medication side effects, thyroid or excess vitamin B12 deficiency, abnormal calcium levels and abscesses in the brain.

The greatest risk factor in dementia is age, and as Americans live longer, the threat of Alzheimer's will continue to increase. The Alzheimer’s Association estimates that 4.5 million Americans now have dementia. It further affects more than a third of U.S. adults through a family member or friend who has Alzheimer’s. Three out of five people surveyed were concerned that they may someday have to be a caretaker for someone with Alzheimer’s. Although eight out of 10 people said they think it is important to plan ahead for the possibility of getting Alzheimer’s, they have taken no steps to prepare for the possibility of Alzheimer’s.

Apart from staying healthy, eating a balanced diet and generally staying mentally active, few options exist for stopping dementia. It is a degenerative disease that progressively weakens the capacity to function.

As a community, we still have not learned how to deal with this disease. The fear that cancer engendered is being replaced by “dementiaphobia.” The very word dementia inspires a degree of fear that “heart attack,” “stroke” or even “kidney failure” often do not. Any of these conditions can kill. Yet somehow, to many of us, the idea of dementia seems more horrifying. Perhaps we fear the idea of losing who we are—becoming a stranger in an unfamiliar body.

The unknown fuels fear. If you are one of the majority who has signs of dementiaphobia, start by finding family members or friends who have early stage dementia and talk with them. Converse. Keep the discussion simple, be patient and show compassion. You will be amazed how successful you will get at learning how to communicate differently. The fear will subside, maybe not completely diminish, but you will be able to see the disease without any emotional baggage.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Dying Older Adults

How would you like to die?  Gilbert Meilaender from Valparaiso University in Indiana suggested a one-word answer: Suddenly!  The idea is to live as long as we can at the peak of our powers, then fall off a cliff.  Doubtless he is right about contemporary attitudes toward death. If we have to go, let it be quickly and painlessly.

Last month a local woman, Sharlotte Hydorn, gained a measure of negative notoriety by offering to mail you, for only $60, a package containing a plastic bag, medical tubing, a canister of helium and instructions on how to commit suicide—by placing the bag on your head and filling it with helium which deprives the body of oxygen. The State of Oregon, one of the few states where physician assisted suicide is legal, was exploring the possibility of suing her.

These two perspectives point to the schizophrenic relationship many of us have with death. What we say we want is frequently quite different from how we deal with death. Since more than a quarter of us will likely die in an emergency room, our final departure might look more like a medical failure rather than a dignified release of life.

Despite the availability of hospice care—both at home and at hospitals, which often involves palliative care targeted to relieve pain—most older adults still experience widespread distress in the final stages of life. We have few guidelines how to deal with death or bereavement in older adults—even when death is not only inevitable but desired. The now classic Kubler-Ross’s process of bereavement—involving phases of denial, anger, rationalization and acceptance—was developed by her observation of children’s reactions to death.

Sherwin Nuland, an American surgeon, has made the point that death in older age is often a protracted affair, rather than a clear-cut process that allows patients and those bereaved to go through the classic end of life stages. He quotes an elderly patient as saying, “Death keeps taking little bits of me.”

Ever since it was eliminated as an official “cause of death” in 1951, we cannot die of old age. We have to die of a disease or trauma. In truth, there is only one real cause of death—oxygen starvation to the brain. The cause of death listed on death certificates is really the cause of the cause. As simple as this might seem, formalizing a definition of death was not easy, but we have been pioneers in California.

In 1973 hospitals threatened to cease organ transplants since criminal defense attorneys argued that harvesting a victim's organs while his heart was still beating caused the death. Dixon Arnett (R-Redwood City) introduced emergency legislation to recognize death when brain activity ceases.  This definition of death is now accepted across the world.  Despite such advancement, we still have difficulty preparing for death. Dying suddenly and painlessly might be our ideal, but we do very little as a society to give older adults that option.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Brain Fitness and Dementia and How We Can Re-Program Our Mind. The Story of Hormesis

Hormesis is the term used to explain the benefits of low exposures to toxins and other stressors as a kind of vaccination. Some of us take vaccinations every ear against the flu, so the concept of hormesis “what does not kill you makes you stronger” is not new. But can we apply the same concept to learning and developing our brain?

Psychologists think about learning in stages of development. Jean Piaget, a Swiss development psychologist, asserted that you can only teach infants what their development allows them to learn. Sigmund Freud also discussed stages of psychosexual development where each stage has its own set of learning requirements that determine our future emotional development. These stages have primed researchers to assume that changes to the brain stopped at adulthood. It is of little surprise, therefore, that anyone studying aging before 1960 looked at aging only as a period of loss and attrition.

David Snowdon’s research with Catholic sisters of Notre Dame living in Mankato, Minn., highlighted one of the paradoxes of aging—why some people who have the disease in the brain (neuropathology) continue to function normally; while others who do not have the disease seem to express demented behavior.  This study has made us re-evaluate how we think about dementia and learning in general because it shows us that we seem to have a reserve of brain cells. The question is how do we grow that reserve?

A developing body of knowledge shows that undertaking certain activities enhances and grows the brain in adults.  For example, studies show that London taxi drivers develop a larger part of their brain while learning different routes in London, than bus drivers who have a set route. Other studies that show that brain increases in size when medical students study for their exams, compared to brains of students who were not studying for exams.

Another popular and consistent finding relates to music and dancing. In a longitudinal study, growth in the hippocampus part of the brain was recorded among music students after two semesters of intensive musical training. A further study showed that participants over 75 years who frequently played a musical instrument and/or danced were less likely to have developed dementia over a five- year period.

These studies repeatedly show that the brain of older adults can develop a reserve of cells. The question is what works best in growing these extra cells?

In understanding what is happening scientists have come up with the Japanese term 苦労 (kurou), which stands for “hardship” and “labor.”  Learning happens when we are uneasy about what we know and make ourselves learn. Geoff Colvin In his book Talent is Overrated similarly argues that there is a learning zone which is above the comfort zone and below the panic zone—where all learning needs to take place. This mirrors Jean Piaget’s definition of intelligence —". . . what you use when you don't know what to do." We need to put ourselves in learning situations that make us uncertain. The uniqueness of the situation will trick our brain to develop ways to learn. What does not kill you makes you stronger.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and is currently on sabbatical at the University of Melbourne, Australia. He can be reached at mariusgarrett@yahoo.com

Ageism-Modern Variants

Robert Butler, who died last year—was a physician, gerontologist, psychiatrist, Pulitzer Prize-winning author, and the first director of the National Institute on Aging—introduced the term “ageism” in 1969. By assigning a word to the practice of discriminating against older adults, researchers gained a focus. Words serve as bridges between action and understanding. By selecting specific words, we provide a strong indication about our beliefs—and probably actions—in relation to members of a group.
Ageist vocabulary—like other forms of prejudicial communication--is potentially harmful. Certain negative words refer to older adults’ physical appearance (decrepit, frumpy, wrinkled); behavior (crotchety, fussy, garrulous, grouchy, grumpy, miserly); physical ability (debilitated, feeble, infirm, rickety); sexuality (unattractive, impotent, sagging, droopy); and mental ability (doddering, eccentric, feebleminded, foolish, rambling, senile).
Despite the abundance of disparaging expressions for older adults, however, a few favorable terms, such as mature, mellow, sage, venerable, veteran, and wise, describe positive aspects of aging. “Old” has a negative connotation only when applied to people. Old implies positive meanings when applied to objects such as money, brandy, wine, cheese, lace, and wood.
Gerontologists still debate the appropriate designation for people older than 65.  A classic 1979 Harris Poll conducted for the National Council on the Aging indicated that the most-favored descriptive terms for older Americans were senior citizen, retired person, and mature American. While gerontologists Carole Barbato and Jerry Feezel, by sampling 162 people in 1987, also came up with those same three terms and added three more in order of preference—retired person, golden ager, and elderly. These terms seem antiquated today in reference to emerging baby boomers.
In contrast, the Thesaurus of Aging Terminology (8th edition 2005), an AARP publication, advises readers to use the expression “older adults.” In politically correct environments, older adults do not represent an end but a process (older vs. old.) The term is inclusive.
Because older adults (aged 65 years to theoretically 122) are extremely heterogeneous, it makes little sense to put a 65-year-old in the same category as a super centenarian (110 years old). “Old person” is a conceptual metaphor that considers old age as a terminal period. “Older adult” does not designate a terminal stage. It implies that you are still growing old, but with the emphasis on “growing.”
Another subtle expression of ageism occurs when referring to part of a person. Whether it is age, or another aspect of that person, the use of a part for the whole is termed a metonymy. Within health care and social service settings, metonymy is a common way to allude to older adults. The use of such expressions; the care recipient, the dementia, the broken hip, or the cancerous liver, are examples.
In some respects, these references underlie the intent of service providers to address specific issues rather than the individual. But words we use determine how we are treated. Part of the secret of long life is not to accept negative terms for us. How long we live is related to our perception of how long we expect to live, and what we allow others to dictate for us. 

Dancing away Dementia

As we age, we experience an increase in body fat, reduced muscle mass, strength and endurance, and diminished balance and aerobic capacity. Normally these deficits result in slowly diminished levels of our functional ability. The resulting loss of functional ability can result in susceptibility to falls, inactivity, and depression.  This in turn can exacerbate existing conditions or contribute to new, chronic diseases such as diabetes, stroke, cardiac infarction, or cancer.

The advice we hear usually involves “exercise and diet.”  But there might be more to this than meets the eye.

The benefits of dancing, for example, exceed mere physical exercise. One can easily see the primary benefits include improved balance and a reduced risk of falls. Dance has also been shown to have considerable physical benefits for older adults with arthritis, osteoporosis, and neurological conditions.

As early as 1989 Robert Katzman and Joe Verghese (2004) from the Albert Einstein College of Medicine were researching other benefits from dancing. In a 21-year study of older adults, 75 years and older, they examined the extent to which physical or mental recreational activities influenced brain health.  They studied mental activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments.  And they studied physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework. One of the surprises of the study was that almost none of the physical activities appeared to offer any protection against dementia with one important exception:  frequent dancing. Mental activities that offered similar protective benefits included playing an instrument and playing board games.

Music and dancing are becoming central features of healthy longevity.   Perhaps dancers and musicians are more resistant to dementia as a result of having greater cognitive reserve. They have more ways of thinking.  We have a word for this--neurogenesis--where our brain constantly rewires its neural pathways through dancing and playing music.

Gerontologists still argue why dancing shows benefits and playing tennis for example, does not.  Research using computer exercises show that engaging in unique events stimulates the brain to react and develop. Unstructured dancing, which requires instant reaction to your partner’s movements, stimulates the connectivity of your brain.  Unique and even frustrating classes have better results, as they create a greater need for new neural pathways. Dancing also makes your gait look better and you become more attractive.

In a study in 2005 William Brown and colleagues at Rutgers University found that people appear to be able to pick desireable partners based on the way they dance. The researchers analyzed 183 young dancers by attaching infrared markers and filmed the markers for one minute. Then they asked peers to evaluate how well the computer-generated figures danced. They found that skillful dancing is associated with desirability and attractiveness.

Dancing simultaneously involves movement, social engagement, musical appreciation, emotional expression and makes you more desirable. Repeating the poet Edwin Denby, “There is a bit of insanity in dancing that does everybody a great deal of good.“ 

HIV/AIDS among Older Adults

Hollywood sells the sexual revolution with ever changing but always young protagonists.  The reality looks much different, with older adults having more sex than we expect. A recent AARP study published in 2010 reports that for older adults aged 60 to 69, 42 percent of males and 32 percent for females had sexual intercourse in the past week or month. Although sexual activity declines with age, it does not go away. Even those 70 years and older, 22 percent of males and 11 percent of females report having sexual intercourse at least once a month.

Sexual activity comes with the risk of Sexually Transmitted Diseases (STDs). STDs refer to more than 25 infections transmitted primarily through sexual activity. Despite STDs being preventable, these diseases remain a significant issue, especially because some—especially HIV/AIDS—can kill.

STDs remain a hidden and quiet epidemic among older adults. But a perfect storm is brewing. Older adults who recently divorced or widowed started entering the dating scene again. Older women may be especially at risk because age-related vaginal thinning and dryness can cause tears that increase susceptibility to infection. Older men—although lacking experience and knowledge of STDs—seem to have an aversion to using condoms and other safe sex methods. With new easier access to partners through Internet dating, perceived lack of susceptibility and the use of Viagra, older adults are prime candidate for STDs, and statistics are now proving this susceptibility.

The Center for Disease Control and Prevention (CDC) reports that the number of persons aged 50 years and older living with HIV/AIDS continues to increase. In 2005—the latest data we have for older adults—one in four persons with HIV/AIDS was an older adult. This rate increased from one in six in 2001. Of all new cases of HIV/AIDS, one in seven is among older adults and a third of all deaths with AIDS are among older adults.

This increase is partly due to people living longer with the disease—especially due to the highly effective antiretroviral therapy (HAART)—and partly due to new infections.  However, it does not affect older adults equally.  HIV/AIDS rates among older adults are 12 times higher among Blacks and 5 times higher among Latinos compared with Whites.

The lack of testing, and subsequent identification of HIV/AIDS, prevents early detection and early treatment.  Health care professionals may underestimate older adults’ risk for HIV/AIDS. Also some symptoms mimic conditions wrongly associated with aging, for example, fatigue, weight loss, and mental confusion. Early diagnosis, which typically leads to the prescription of HAART and to other medical and social services, can improve a person’s chances of living a longer and healthier life.

Although the sexual revolution continues into older age, be wise and take care of your health by practicing safe sex. For HIV testing the county has a number of sites (including at all STD clinics). You can reach County Health Services Complex at 619-296-2120. The same number also connects you to an HIV Mobile testing unit that does home visits. In addition, people can reach the San Diego LGBT Community Center at 619-692-2077.

Plastic Surgery-Looking Younger in Older Years

Unsatisfied with living longer, some of us also want to look younger. In 2010 the American Society of Plastic Surgeons published national statistics on plastic surgeries. This report tells a story about vanity and the unyielding pursuit of youth.

Last year, Americans spent $10.1 billion on plastic surgery, more than the 2010 budget for the National Science Foundation (and close to the budget of the Environmental Protection Agency).

The surprise is that following the 40-54 year olds--who account for nearly half of all plastic surgery procedures--the main clients are seniors--those 55 years and older!  This older group had more surgeries, cosmetic procedures and minimally invasive procedures than 20-39 year olds.

While most popular procedures among young adults focus on their bodies, older adults are apparently more concerned about more visible features, such as their faces.

Americans aged 55 years and older had 3.3 million cosmetic procedures. Most involved having no surgery at all, opting instead for injections. The most popular procedure--performed 1.2 million times last year--was botox injection, followed by more than a half-million soft tissue fillers (injections of Hyaluronic/polyactic acid, fat, collagen, or calcium hydroxyapalite).

In comparison, for surgeries, nearly a third of these 349,000 procedures involved  eyelid surgery (100,000), followed by facelifts (74,000), dermabrasions (27,000), nose reshaping (24,000) and hair transplantation (23,000). Two out of three facelift surgeries in 2010 were performed on patients who were 55 years and older.

Even though plastic surgery might belong primarily to the wealthy, it is no longer the exclusive domain of Whites. Since 2009, all minorities have shown an increase in the use of plastic surgery--up by 6% for African Americans and 2% equally for Latinos and Asian Americans. The trend is one of convergence. While for African Americans the top procedures include liposuction, nose reshaping and breast reduction, for Asian-Americans it is breast enlargement, nose reshaping and eyelid surgery. Latinos’ top procedures include breast enlargement, liposuction and nose reshaping.

Apparently, Americans of all races share a fixation with physical appearance--one that seems to increase as we age. Do we think we can cheat death by looking younger? In a seven-year study led by Kaare Christensen of the University of Southern Denmark, researchers found that people who looked younger lived longer. Their report published in 2009, asked people to guess the age from photographs of faces of 387 pairs of twins in their 70s, 80s or 90s. They found that the older looking twin is more likely to die first. Surprisingly, the older looking twin also had shorter telomeres--telomere length indicates cell longevity, the longer the telomere the longer the cell will live.

Does plastic surgery, by making us look younger, also “teach” our telomeres to grow? Probably not.

People who have had a tougher life are more likely to have such stress etched in their faces, while at the same time the stress shortens their telomeres. We might modify how our faces look, but those telomeres are still getting shorter.